Law Commons^™

Cost-Effectiveness Comes To America: The Promise And Perils Of Cost-Effective Analysis In Medication Coverage Decisions, Carl Coleman

Georgia State University Law Review

In an effort to control rising drug costs, some health insurers have begun experimenting with methods to link decisions about coverage to the value added by medicines, including through the use of formal cost-effectiveness analysis (CEA). Increased interest in subjecting new drugs to rigorous economic analysis is a welcome development, as it offers the potential to minimize wasteful spending on drugs whose high prices are not justified by evidence of additional benefits produced. At the same time, CEA raises significant ethical issues, particularly when payers use it to limit access to drugs deemed to provide insufficient value for money. For …

404 Provider Not Found: Contributions And Solutions To Inadequate Provider Networks For Behavioral Health Care, Travis Williams

Georgia State University Law Review

Despite the efforts of policymakers, access to in-network behavioral health care services has continued to lag relative to other types of health care. Many psychiatrists, for example, do not accept insurance, limiting access to their services to only those individuals who can afford to pay out of pocket. Several factors contribute to insurance networks’ paucity of behavioral health care providers, including low insurance reimbursement for behavioral health care services, inadequate regulation and enforcement, provider shortages, and a lack of access to telehealth services. To maximize the utility of existing regulatory structures, states should take an outcome-oriented enforcement approach that principally …

Does Size Matter? Nanoscale Particle Size As An Indicator Of Inherency In Nanopharmaceutical Patent Validity, Kirsten Fehlan

Georgia State University Law Review

Scientific and technological advances in nanopharmaceuticals bring the doctrine of inherent obviousness to a head. On the one hand, nanotechnology promises to offer novel ways to target and treat traditionally incurable diseases by operating at a scale that is comparable to the scales that most biological systems use. On the other hand, nanotechnology inventions that result in improved pharmacokinetic properties are susceptible to validity challenges based on inherent obviousness.

Inherency and obviousness are two independently recognized and well-understood principles in United States patent law. Inherency refers to a claimed limitation or feature that is either necessarily present in, or the …

Determining The Appropriate Reach Of Escobar's Materiality Standard: Implied And Express Certification, Jake Summerlin

Georgia State University Law Review

In 2016, the Supreme Court altered the landscape of the False Claims Act by recognizing implied certification as a viable theory of liability. Before the Court decided Universal Health Services, Inc. v. United States ex rel. Escobar, courts disagreed over the scope and legitimacy of the theory, arguing that it could create runaway liability if not held in check. The Court, although recognizing that implied certification expanded the reach of the False Claims Act, reassured itself and government contractors by reinforcing the common law antecedents of fraud, namely, that misrepresentations and omissions must be material to the government’s decision …

Hb 128: Prohibition Of Discrimination Against Potential Organ Transplant Recipients, Sarah Beach, Anne Marie Simoneaux

Georgia State University Law Review

The Act functions to prohibit discrimination by health care providers and insurers against potential organ transplant recipients due to physical or mental disabilities. Also known as Gracie’s Law, the Act provides a pathway through local courts to enforce compliance, and an affected individual may bring a civil action for injunctive and other equitable relief. In addition, the Act incorporates Simon’s Law, which provides that an order to not resuscitate a minor child can only be issued with the consent of the minor’s parents.

Hb 112: Extension Of The Pandemic Business Safety Act, Reid Hansen, Britt Spurka

Georgia State University Law Review

This Act amends the Pandemic Business Safety Act to extend its applicability for an additional year, expiring on July 14, 2022. The Pandemic Business Safety Act provides liability protection limitation to business against tort claims arising from the COVID-19 pandemic.

Hb 1013: Georgia Mental Health Parity Act, Justin Crozier, Betsy Hicks, Jordan Kalteux

Georgia State University Law Review

The Act overhauls Georgia’s mental health system by enforcing compliance with federal mental health parity law. Most notably, the Act requires health insurers to provide coverage for mental health and substance use disorders equitably with physical health and defines generally accepted standards of care. The Act requires insurers to submit annual parity compliance reports and requires the Commissioner to make annual data calls and submit annual reports. The Act requires compliance with a minimum 85% medical loss ratio. The Act provides for cancelable loans to Georgia residents enrolled in related educational programs and creates grant programs for accountability courts. The …

Hb 752: Psychiatric Advance Directive Act, Andrew Krawtz, Adam Xie, Matthew Sweat

Georgia State University Law Review

The Act amends Georgia laws relating to mental health and provides a statutory psychiatric advance directive form. The Act allows citizens with diagnosed mental health disorders to appoint a mental health agent to make treatment decisions on their behalf. The Act delineates the responsibilities, duties, and immunities of physicians and other providers using a psychiatric advance directive and clarifies the psychiatric advance directive’s interaction and relationship with other types of advance directives for health care.